Ward_X

This! I don't think consulting a hematologist is even on the care team's mind in terms of these bleeders, which is unfortunate, because if there is an underlying coagulopathy that isn't being treated the products will just run right in and out of the patient with little to no benefit. I guess in terms of traumas, doctors assess the needs for blood and know that's how to save them at that point. Obviously send them RBCs first, but after using x amount of products, what about tranexamic acid!!

If they have a historical type on file, you do not need a current T/S to issue plasma and platelet products. For RBCs you do need a current T/S.

First, I would educate the trauma team on the differences between an actual MTP (in terms of products prepared, and the fact its >10 products in 24hrs), and regular emergency release. That's not to say to ever deny them a protocol if they call for one, but from firsthand experience when I receive a call asking for the phrase "Massive Transfusion Protocol," and I verify what products they will be getting, they don't actually want the sheer number of rounds/number of products listed in our MTP. These areas just know an MTP will deliver products stat, and with relative ease. So, in that case, having pamphlets, posters, what have you, in their areas would be beneficial, as well as explaining about regular old emergency release options (i.e. maybe they only want RBCs, but they only know about MTPs, so they call for that). Just explaining to them that this is an option may reduce the amount of products you're issuing compared to the products they end up using. That being said, our MTP states our first round is 6:6:1, and then a subsequent round is set up after that, and additional rounds in the same 6:6:1 ratio as needed. We are also a Trauma I center, so our numbers might be higher than yours. However, there have been studies, particularly driven by the US Army, about the "optimal" ratio of RBC:plasma:platelets. If you're worried about platelet wastage, that is an honest concern, but in true MTPs, massively bleeding is still massively bleeding; in which case the products may just dribble out. At the end of the day, it's about pluggin' holes and treating the underlying coagulopathy.

Blood Bank Guy is a great resource, although I don't know exactly how many different cases he has on his website. There are videos here and also here that go through a few.

Is there a sort of alias/admission MRN that can be created upon the pt coming to the hospital, that can later be merged? We use this with EPIC, they get an alias name and MRN that we can use for issuing until it is later merged with their real ID. We have names generated that avoid using Jane/John Doe.

Yup! On each sheet of the carbon copy packet. We also have a barcode replicator (BUI) to copy and make scan-able unit stickers if we needed (although seldom ever needed). I'm used to HCLL, where emergency issue is sort of a separate function from regular issuing... does Softbank not have this capability?

I like the sound of the insulated bags, actually We just use high-density opaque white bags for issuing in-person pickups, and clear ziploc plastic bags for issuing products through our pneumatic tube system. The theory is that they'll get the product and issue within 30 minutes, but sometimes we do get returns and they fail temperature check because they were placed on countertops or wherever they land up in room temp...

As far as my interpretation of this standard and how my facility operates, the training is not the same thing as the competency testing. Each area of the lab has an initial competency testing, then the 6 month, then the corresponding annual along with everyone else. I don't think mere completion of training without an initial competency assessment is sufficient. Training is often just acknowledging the trainee has been taught a task and can perform said test; the competency is a pre-set blind sample that already has a determined result, so you can tell if your trainee is passing/failing the competency. I would say: sign off training, sign off competency, then you can perform solo testing. There is a previous thread here, and another here about GEN.55500 that may be helpful?

I'm in a trauma I center with an MTP policy that was forced to update post mass casualty. We set up MTP packs ahead of time and have them at the ready for any moment. Each pack is distinguished by gender (O NEG set up for females, O POS set up for males), and is complete with 6 units of RBC, a carbon copy form, cooler card, and pulled segments. The carbon copy form has the record of the unit numbers, but we use stickers from the unit itself. The only info really handwritten is the ABORh of the units, the product code, and the time/date whenever the pack is issued to a patient. Since the pack is set up ahead of time, one tech prepares the pack and a second tech verifies that the units are in an acceptable status to issue, and that the pack is overall assembled correctly -- therefore reducing a number of potential errors. At time of issue, we use ADT labels printed from EPIC that include the pt's information, and this sticker is applied to the carbon copy sheets and the BTRs already tagged to the units.

We don't ignore the "weaker" agglutinations -- we still record M reactions... however, the result of the titer is the last dilution that is graded >M (i.e. is graded 1+). We have a test result called "below titerable levels" for a titer that doesn't have reportable results similar to what you are describing.

Is there a way to verify that information is correct? You're otherwise relying on a third-party data collection service, so I'm just curious how we can use sites like Ancestry or BillionGraves

If you have resources, I'd still be happy to take them.

My lab is also partnering with a transport transfusion service and I've wondered the same thing. Perhaps you'd need to register the pt regardless just to document the use of units or, The chopper should only have blood on it from the particular hospital that it would transfer pts. or, Operate like you suggest and make transfers to that service (however, how do you document proper transfer physically?) I would say if you're transfusing in the chopper (sort of a middle ground, under the jurisdiction of your hospital), you need to document that a pt was transfused under your control, just at a satellite location. The pt being moved after transfusion to another facility doesn't mean Facility #2 has to deal with the units/transfusion... does that make a sort of sense for sake of discussion?

You're mainly going to receive input on the laboratory side of things, not so much the nursing administrative side. There's really only guidelines on the timing of the start of transfusion post-issue from the Blood Bank, and that's really just for temperature acceptability & storage conditions...

We've caught misdraws twice the last month from samples that required a 2ABORh/didn't abide by proper electronic collection... it's safe to say the hassle is beneficial!